If you've been struggling with an uncomfortable and embarrassing bladder control problem, you have plenty of company.

"Approximately 13 million Americans have some form of urinary incontinence, and 85 percent of them are women," says Dr. Mark Saleh, a urologist with Washington Township Medical Group. "Up to 50 percent of all women will be affected to some degree by bladder control problems at some point in their lives."

To help women take control of their bladder function before it takes control of their lives, the Washington Women's Center will be presenting a Lunch and Learn Lecture featuring Dr. Saleh on Thursday, January 8 from noon to 1 p.m. Dr. Saleh will discuss the anatomy of the female urinary tract, the major types of incontinence, various treatments and resources for additional information.

Bladder control problems affect women more frequently than men because of the structure of the female urinary tract. Pregnancy, childbirth and the hormonal changes associated with menopause can play significant roles, weakening the muscles and ligaments that support the bladder. But even younger women in their 20s and 30s who have not had children can be affected by muscle or ligament damage caused by physical activities such as jogging or lifting heavy objects.

Types of Urinary Incontinence

"The most common type of urinary incontinence is called 'stress incontinence,' which occurs when coughing, laughing, sneezing, lifting or other activities that put pressure on the bladder cause you to leak urine," Dr. Saleh explains. "This happens because the pelvic floor muscles and ligaments that support the bladder and urethra have been weakened, and urine from the bladder can leak during moments of physical stress."

Another type of incontinence, "urge incontinence," occurs when you unexpectedly lose larger amounts of urine for no apparent reason after suddenly feeling a strong urge to urinate. A possible cause for urge incontinence may be abnormal nerve signals that cause bladder spasms. Urge incontinence can occur during sleep, after drinking a small amount of water or when you touch water or hear it running.

Overactive Bladder

Urge incontinence actually can be one symptom of having an overactive bladder. Other symptoms might include:* Urinary frequency - having to urinate more than eight times a day or two or more times at night.* Urinary urgency - the sudden, strong need to urinate immediately, or what Dr. Saleh refers to as the "gotta go, gotta go" syndrome.* Nocturia - waking at night to urinate.

"Most of the time, overactive bladder is idiopathic, which means we are not sure of the cause," Dr. Saleh says. "It could be related to factors such as weak pelvic muscles, a bladder stone, an infection or inflammation. Sometimes it's a combination of those problems."

Self-help Treatments

If your symptoms are not severe, you may be able to improve your bladder control with a few simple lifestyle changes.

"It may help to avoid drinking too much fluid, particularly beverages that contain alcohol or caffeine," Dr. Saleh advises. "Also, you should avoid letting your bladder get too full - don't try to wait until the last minute to urinate. Instead, try 'timed voiding' where you go to the bathroom on a set schedule. Many women find it helpful to practice Kegel exercises to strengthen the pelvic floor muscles. Your physician can teach you the proper way to do these exercises."

Other measures that may be beneficial in improving bladder control include losing weight if you are overweight and quitting smoking.

Medications for Overactive Bladder

When self-help treatments fail to improve your symptoms of overactive bladder, your physician may prescribe medications to correct the problem.

"The primary type of medications for overactive bladder are anticholinergics," Dr. Saleh explains. "These medicines work on the nerve receptors that stimulate the bladder muscles to contract. Reducing the activity of the nerve receptors helps prevent bladder spasms."

Treating Stress Incontinence

Because there are no medications that effectively treat stress incontinence, other techniques may be required to control the condition if self-help measures don't work.

"One possible treatment involves inserting a stiff ring called a pessary into the vagina, where it helps prop up the uterus, which may be pressing on the bladder," Dr. Saleh says. "This is a very simple procedure, and it can be performed by a primary care physician or OB/GYN during an office visit."

Another technique used in treating stress incontinence is to inject a "bulking agent" similar to collagen into the tissues around the urethra. "This is a minimally invasive procedure that requires only a light anesthetic and can be performed as an outpatient procedure," he notes. "The bulking agent makes the tissues thicker and increases the resistance of the bladder opening to reduce stress incontinence. It is generally used for more minor cases of incontinence."

Surgical Options for Stress Incontinence

As a last resort, your physician may recommend surgery to correct stress incontinence.

"Retropubic surgery to lift the bladder up does work well, and it used to be the treatment of choice for stress incontinence," Dr. Saleh says. "This is a type of open surgery, though, and it requires a large abdominal incision and a lengthy recovery time."

An alternative surgical technique called a sling procedure is now used more frequently than open retropubic surgery. The surgeon makes a small vaginal incision and inserts a sling that holds up the bladder neck and urethra.

"The vaginal incision is much smaller, and the procedure can be done under light anesthesia in about 20 minutes on an outpatient basis, with minimal post-operative pain," Dr. Saleh explains. "The procedure is very effective and works well for most women with stress incontinence, even more severe cases."

The Washington Women's Center is located at 2500 Mowry Avenue in Fremont, across the street from Washington Hospital. For more information about the Lunch and Learn Lecture or to register to attend, please call (800) 963-7070.